What is it like to have Medicare as your primary insurance, in particular for durable medical equipment, such as prostheses or wheelchairs?
Dear Shifting Forward,
Medicare Part B does cover durable medical equipment, including prostheses and wheelchairs. See Medicare.gov’s list. “Part B” is Medicare’s coverage for physician services and other out-of-hospital items. It is also the part that requires you to pay each month for the coverage. If you are receiving Social Security retirement payments, they will deduct your Part B premiums from your check. (In 2014, most people pay $104.90 per month.)
The other important thing about Part B is that it has a deductible and co-insurance. This means that you pay a certain amount up front before the plan pays anything. In 2014, the Part B deductible is $147. The co-insurance means that you pay a percentage of the bill. For medical equipment, you will pay 20% of the charges. The charges are negotiated by Medicare.
Keep in mind that Medicare does not put a limit on how much you pay out of your own pocket. The 20% of the wheelchair cost might be a few thousand dollars. If you want to have a cap on your out-of-pocket expense for medical bills and you have Medicare, you need to get a “Medigap” or Medicare supplemental plan. You need to get this plan soon after you start on Medicare; if you wait, insurers will charge you a penalty. The penalty will increase your monthly cost for the coverage.